Cuts Taking Effect Within A Month Remove Access To Tools Doctors And Patients Need To Manage Diabetes

Augusta, Maine The American Diabetes Association (ADA) today called on Governor John Baldacci and Department of Health and Human Services Commissioner Jack Nicholas to rescind pending cuts to MaineCare, the states health care safety net for the poor and disabled, that will harm people with diabetes. The cuts will leave many Maine adults living in poverty with no or inadequate coverage for vital care and medical supplies required to properly manage diabetes.

Next month, MaineCare will end coverage for many services and health needs for MaineCare recipients in the non-categorical eligibility group, which includes hundreds of adults with diabetes. The cuts to diabetes care and supplies will limit the ability of patients and their physicians to control diabetes, increase the risk for additional medical complications due to unmanaged diabetes, and potentially lead to disability and death while increasing healthcare costs borne by Maine taxpayers.

Maine is forcing doctors and impoverished adults with diabetes to fly blind when it comes to managing the disease, said Stephen Sears, MD, of Farmingdale, Senior Vice President and Chief Medical Officer at Maine General Medical Center. Balancing the state budget on the backs of poor people with diabetes is inappropriate. If Maine proceeds with these cuts, impoverished adults with diabetes will be forced to go without critical diabetes care. Hopefully the recent announcement of a delay in benefit cuts means Maine will reconsider the changes that leave many in Maines vulnerable diabetes population without the tools needed to control diabetes and its complications.

Proper treatment of diabetes requires a balance of daily self-management by people with diabetes coupled with structured physician visits. Patients need the ability to monitor their blood glucose levels and adjust medications to maintain glucose levels within a normal range through a careful balance. Likewise, physicians need the ability to order an array of laboratory tests to ensure that patient activities, diet, exercise, medications and related medical supplies are effectively used by a patient. People with diabetes require affordable access to necessary supplies like a blood glucose monitor, blood glucose strips, lancets, and insulin pumps and pump supplies or syringes. They also require appropriate medical care, medications like insulin and a variety of oral medications to control diabetes and its complications.

The state of Maine plans to make controlling and managing diabetes exceedingly difficult and expensive for poor people. First, the state plans to eliminate MaineCare coverage of basic diabetes necessities for patients with the disease. The cuts include eliminating coverage for insulin pumps, pump supplies, blood glucose meters, and podiatry services (lower limb amputations are one of the major complications related to diabetes).

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Planned limits on prescription items will create barriers to patient access for medications like insulin and supplies such as blood glucose test strips and syringes for this population. Without proper coverage to control ones diabetes by adequately measuring blood glucose levels and administering insulin and other diabetes-related medications, MaineCare recipients will be at risk for the serious complications associated with diabetes, and potentially death and disability. Heart disease, kidney disease, lower limb amputations and blindness are the major complications related to diabetes.

In addition to the above cuts, the elimination of coverage for lab services means doctors cannot order screening tests for diabetes, A1C tests used to determine if a patient with diabetes is in control of the disease, cholesterol tests and related blood tests to manage heart disease related to diabetes, and diagnostic and ongoing tests for kidney disease. Affected patients with diabetes and their physicians cannot manage diabetes without access to the laboratory test results being eliminated by MaineCare. As a result of these changes, physicians and their patients will find it impossible to modify insulin doses, have substantial difficulty adding or modifying medications to manage diabetes, and have an inability to prevent and manage heart disease and kidney failure that can result from the patients diabetes.

Providing the tools and care needed to control diabetes and keep people healthy is far more cost-effective than having to treat serious medical complications down the road, said Julie Barnes, RD, CDE, Clinical Coordinator at Maine Center for Diabetes in Scarborough. We have known since the results of the Diabetes Control and Complications Trial were published, that a significant reduction in diabetes-related complications, such as kidney and eye diseases, can be achieved when diabetes is well controlled.

Barnes noted that diabetes control is typically measured with a blood test called an HbA1c. The standard of care is for people with diabetes to have this test done every three to six months, with the goal being a result of <7%. At least one study has revealed a significant increase in medical expenses per patient for each 1% rise in this test. Unfortunately, lab tests is one of the many categories of benefits lost to these MaineCare beneficiaries, said Barnes, who is also a volunteer with the American Diabetes Association. Diabetes places a substantial toll on Maine - 7.4 percent of the states population was diagnosed with diabetes in 2003. Nationwide, over 18 million Americans have diabetes. In 2002, one in 10 healthcare dollars and one in four Medicare dollars went towards diabetes care.

Despite these costs, the Centers for Disease Control and Prevention have concluded that for every $1 spent covering people with diabetes, $3 will be saved in health care costs for diabetes-related complications. The American Diabetes Association is the nations leading voluntary health organization supporting diabetes research, information and advocacy. The Associations advocacy efforts include helping to combat discrimination against people with diabetes; advocating for the increase of federal diabetes research and programs; and improved access to, and quality of, healthcare for people with diabetes. The Associations mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes. Founded in 1940, the Association provides service to hundreds of communities across the country.

For more information please call the American Diabetes Association at 1-800-DIABETES (1-800-342-2383). Information from both these sources is available in English and Spanish.

Source: American Diabetes Association